Electrical risk score beyond the left ventricular ejection fraction: prediction of sudden cardiac death in the Oregon Sudden Unexpected Death Study and the Atherosclerosis Risk in Communities Study.
Aapo L Aro, Kyndaron Reinier, Carmen Rusinaru, Audrey Uy-Evanado, Navid Darouian, Derek Phan, Wendy J Mack, Jonathan Jui, Elsayed Z Soliman, Larisa G Tereshchenko, Sumeet S Chugh
Author Information
Aapo L Aro: Heart Institute, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, Suite A3100, 127 S. San Vicente Blvd., Los Angeles, CA 90048, USA.
Kyndaron Reinier: Heart Institute, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, Suite A3100, 127?S. San Vicente Blvd., Los Angeles, CA 90048, USA.
Carmen Rusinaru: Heart Institute, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, Suite A3100, 127?S. San Vicente Blvd., Los Angeles, CA 90048, USA.
Audrey Uy-Evanado: Heart Institute, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, Suite A3100, 127?S. San Vicente Blvd., Los Angeles, CA 90048, USA.
Navid Darouian: Heart Institute, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, Suite A3100, 127?S. San Vicente Blvd., Los Angeles, CA 90048, USA.
Derek Phan: Heart Institute, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, Suite A3100, 127?S. San Vicente Blvd., Los Angeles, CA 90048, USA.
Wendy J Mack: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N Soto Street, Los Angeles, CA 90032, USA.
Jonathan Jui: Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
Elsayed Z Soliman: Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC, USA.
Larisa G Tereshchenko: Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
Sumeet S Chugh: Heart Institute, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, Suite A3100, 127?S. San Vicente Blvd., Los Angeles, CA 90048, USA.
AIMS: There is an urgent need to extend sudden cardiac death (SCD) risk stratification beyond the left ventricular ejection fraction (LVEF). We evaluated whether a cumulative electrocardiogram (ECG) risk score would improve identification of individuals at high risk of SCD. METHODS AND RESULTS: In the community-based Oregon Sudden Unexpected Death Study (catchment population ∼1 million), 522 SCD cases with archived 12-lead ECG available (65.3 ± 14.5 years, 66% male) were compared with 736 geographical controls to assess the incremental value of multiple ECG parameters in SCD prediction. Heart rate, LV hypertrophy, QRS transition zone, QRS-T angle, QTc, and Tpeak-to-Tend interval remained significant in the final model, which was externally validated in the Atherosclerosis Risk in Communities (ARIC) Study. Sixteen percent of cases and 3% of controls had ≥4 abnormal ECG markers. After adjusting for clinical factors and LVEF, increasing ECG risk score was associated with progressively greater odds of SCD. Overall, subjects with ≥4 ECG abnormalities had an odds ratio (OR) of 21.2 for SCD [95% confidence interval (CI) 9.4-47.7; P < 0.001]. In the LVEF >35% subgroup, the OR was 26.1 (95% CI 9.9-68.5; P < 0.001). The ECG risk score increased the C-statistic from 0.625 to 0.753 (P < 0.001), with net reclassification improvement of 0.319 (P < 0.001). In the ARIC cohort validation, risk of SCD associated with ≥4 ECG abnormalities remained significant after multivariable adjustment (hazard ratio 4.84; 95% CI 2.34-9.99; P < 0.001; C-statistic improvement 0.759-0.774; P = 0.019). CONCLUSION: This novel cumulative ECG risk score was independently associated with SCD and was particularly effective for LVEF >35% where risk stratification is currently unavailable. These findings warrant further evaluation in prospective clinical investigations.
